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Sliding-T Dorsal Inlay Urethroplasty

The "Sliding-T" dorsal inlay urethroplasty is a single-stage buccal-mucosal graft repair for fossa navicularis strictures, described by Hoare, Fersovich, Saavedra and Rourke. Their retrospective series reported success in 25/27 patients at mean 29.6 months. It should be distinguished from separately described glans-sparing transurethral and subcoronal techniques.[1][4][7]

For the broader Asopa dorsal-inlay principle, see Asopa Dorsal Inlay OMG. For graft material, see Buccal Mucosa Graft. For the transurethral variant, see Transmeatal Ventral Inlay OMG.

The Challenge of Fossa Navicularis Strictures​

Fossa navicularis strictures are among the most technically challenging urethral strictures to reconstruct. The ideal repair must simultaneously achieve four goals:[1][2]

  1. An unobstructed urethra
  2. A slit-like meatus (cosmetically normal)
  3. Preservation of sexual function (erectile function, glans sensation)
  4. A cosmetically acceptable glans, with counseling about altered appearance and wound healing

Repeated dilation or urethrotomy often lacks durability. Meatotomy or meatoplasty can be definitive for selected distal disease and should not be grouped with lifelong instrumentation.[3][8][9] The AUA Urethral Stricture Disease Guideline (2023) recommends offering urethroplasty to patients with recurrent meatal or fossa navicularis strictures (Moderate Recommendation, Grade C), noting that strictures related to lichen sclerosus (LS) are more likely to be reconstructed successfully using oral mucosal grafts.[3]

Operative Concept​

The operation augments the distal urethra using a dorsal inlay BMG and a T-shaped reconstruction. Distal graft placement requires suitable glanular tissue, a tension-free mucosal repair and adequate meatal caliber. The glanular graft bed should not be described as the thick tunica albuginea of the corpora cavernosa.[1]

For the named operation and its exact incision sequence, refer to the original operative article. Glans-sparing transurethral inlay and subcoronal dorsal-onlay repairs are distinct techniques; their incision and closure steps should not be substituted for the Sliding-T operation.[4][7]

Outcomes (Rourke Series)​

ParameterResult
Number of patients27
Mean age47.3 yr (range 19–71)
Mean stricture length3.2 cm ± 1.2 (range 1–4)
Stricture etiologyLichen sclerosus 70.4%; iatrogenic 18.5%; idiopathic 11.1%
Prior failed endoscopic treatment92.6%
Prior failed urethroplasty7.4%
Success rate25/27 (approximately 93%)
Mean follow-up29.6 mo (range 12–60)
Recurrence managementBoth recurrences managed with meatotomy
90-day complications (Clavien ≥2)7.4% (2/27) — surgical site infection treated with antibiotics
De novo erectile dysfunction3.7% (1/27)
Chordee3.7% (1/27) — mild
Patient satisfaction96.3% (26/27) satisfied
[1]

Nineteen of 27 patients had LS. This supports feasibility in selected LS strictures but does not establish superiority over other distal repairs. Long-term recurrence associations from a separate mixed-urethroplasty cohort cannot be used as the Sliding-T-specific risk estimate.[1][5]

Other Fossa Navicularis Techniques​

These selected, nonrandomized series differ in anatomy, etiology, success definitions and follow-up; the percentages cannot rank operations.

TechniquenStricture lengthSuccessFollow-upKey features
Sliding-T dorsal inlay BMG (Rourke)[1]273.2 cm25/2729.6 moT-shaped dorsal inlay; single-stage; 19/27 had LS
Transurethral dorsal inlay BMG (Vanni)[4]161.7 cm93.8%28.8 moFully transurethral; no external incision; glans-sparing; shorter strictures
Dorsal inlay BMG (Zumstein / Hamburg)[2]32—69%42 mo50% hypospadias-associated; mixed etiology; longer follow-up
Dorsal inlay oral mucosa (Wirtz / Belgium)[6]40meatal only82.5% (5-yr RFS 85%)85 moLongest follow-up; Observed 5-yr RFS 96% BMG versus 65% LMG; nonrandomized, small groups
Dorsal BMG onlay by subcoronal approach (Favre)[7]165.5 cm100%41.5 moSubcoronal approach; longer strictures extending into penile urethra
Meatotomy (Meeks / Barbagli)[8]73short87%61 moSimplest approach; high satisfaction; best for short uncomplicated strictures
Extended meatotomy / first-stage Johanson (Morey)[9]16complex87%52 moSalvage for complex / reoperative distal strictures
Ventral transverse island flap (Jordan)[10]5variable100%17 moClassic flap technique; requires glans splitting; small series
Ventral island flap + glanuloplasty (Armenakas / McAninch)[11]19variable94.7%42.7 moTailored approach; glans cap or wings; fasciocutaneous flap
Excision + circumferential BMG (Ehlers / Figler)[12]—severe——Glans-sparing transurethral excision; for severe / obliterative strictures
Distal one-stage hybrid (Hofer)[13]270.68 cm82.4%42.5 moNo graft / flap needed for most short strictures; 17.6% recurrence

Potential Role​

This offers one-stage oral-mucosa reconstruction for selected recurrent fossa-navicularis strictures. In the initial cohort, 26/27 patients were satisfied, two developed infections requiring antibiotics, one reported new erectile dysfunction and one mild chordee. Small numbers and a single-center design limit precision and comparative conclusions.[1]

Limitations and Considerations​

  • Single-center experience — described by only one group (Rourke, University of Alberta), 27 patients. Independent validation needed.[1]
  • Stricture length limitation — mean 3.2 cm (range 1–4 cm); may not be suitable for very long distal strictures extending significantly into the penile urethra. For longer distal strictures (>4–5 cm), a subcoronal dorsal onlay (Favre) or staged urethroplasty may be more appropriate.[7][13]
  • Recurrence at the meatus — both recurrences in the Rourke series were managed with simple meatotomy, suggesting the meatal component may be the most vulnerable point of the reconstruction.[1]
  • Comparison with staged repair — for complex LS-related strictures with extensive glanular involvement, staged urethroplasty may be needed when local tissue loss or scarring prevents a sound one-stage repair. The one-stage sliding-T should be selected when the dorsal urethral plate and glans tissue are of sufficient quality to support graft take.[3]
  • LS recurrence risk — LS is a chronic, progressive disease; long-term follow-up beyond 5 years is needed to assess durability (the cited recurrence association comes from mixed contemporary urethroplasties, not Sliding-T alone).[5]

Patient Selection​

Reported experience concerns the following selected patients:[1][3][4]

  • Recurrent fossa navicularis strictures that have failed endoscopic management
  • Stricture length 1–4 cm confined to the fossa navicularis ± meatus
  • Lichen sclerosus etiology (where genital skin should be avoided)
  • Patients desiring single-stage repair after discussion of cosmetic and functional tradeoffs
  • Adequate dorsal urethral plate quality to support graft take (if the plate is severely diseased or absent, staged repair may be preferable)

Postoperative Management​

Catheter duration is individualized, commonly two to three weeks after graft urethroplasty. EAU recommends validated urethrography to assess leakage before catheter removal; a trial of void does not substitute for leak assessment.[14]

Monitor symptoms, flow and residual urine with anatomical reassessment appropriate to recurrence risk. LS requires ongoing assessment, and external genital LS may need topical therapy. Subsequent cystoscopy is selected according to the follow-up protocol and clinical findings.[3][15]

References​

  1. Hoare D, Fersovich JH, Saavedra A, Rourke KF. Single-stage reconstruction of fossa navicularis strictures using a "sliding-T" dorsal inlay urethroplasty with buccal mucosal graft. Urology. 2021;152:201-202. doi:10.1016/j.urology.2020.12.031.

  2. Zumstein V, Dahlem R, Maurer V, et al. Single-stage buccal mucosal graft urethroplasty for meatal stenoses and fossa navicularis strictures: a monocentric outcome analysis and literature review on alternative treatment options. World J Urol. 2020;38(10):2609-2620. doi:10.1007/s00345-019-03035-8.

  3. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol. 2023;210(1):64-71. doi:10.1097/JU.0000000000003482.

  4. Farrell MR, Campbell JG, Zhang L, Nowicki S, Vanni AJ. Transurethral reconstruction of fossa navicularis strictures with dorsal inlay buccal mucosa graft urethroplasty. World J Urol. 2022;40(6):1523-1528. doi:10.1007/s00345-022-03994-5.

  5. Calvo CI, Fender K, Hoy N, Rourke K. Affirming long-term outcomes after contemporary urethroplasty: the adverse impact of increasing stricture length, lichen sclerosus, radiation, and infectious strictures. J Urol. 2024;211(3):455-464. doi:10.1097/JU.0000000000003826.

  6. Wirtz M, Claeys W, Francois P, et al. Treatment of meatal strictures by dorsal inlay oral mucosa graft urethroplasty: a single-center experience. J Clin Med. 2021;10(19):4312. doi:10.3390/jcm10194312.

  7. Favre GA, Villa SG, Scherñuk J, Tobia IP, Giudice CR. Glans preservation in surgical treatment of distal urethral strictures with dorsal buccal mucosa graft onlay by subcoronal approach. Urology. 2021;152:148-152. doi:10.1016/j.urology.2020.12.014.

  8. Meeks JJ, Barbagli G, Mehdiratta N, Granieri MA, Gonzalez CM. Distal urethroplasty for isolated fossa navicularis and meatal strictures. BJU Int. 2012;109(4):616-9. doi:10.1111/j.1464-410X.2011.10248.x.

  9. Morey AF, Lin HC, DeRosa CA, Griffith BC. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol. 2007;177(1):184-7; discussion 187. doi:10.1016/j.juro.2006.08.062.

  10. Jordan GH. Reconstruction of the fossa navicularis. J Urol. 1987;138(1):102-4. doi:10.1016/s0022-5347(17)43006-0.

  11. Armenakas NA, Morey AF, McAninch JW. Reconstruction of resistant strictures of the fossa navicularis and meatus. J Urol. 1998;160(2):359-63.

  12. Ehlers M, Figler BD. Excision and circumferential buccal graft for severe meatus and fossa navicularis strictures. Urology. 2020;146:304. doi:10.1016/j.urology.2020.09.008.

  13. Hofer MD, Cooley LF, Elmasri A, Martins FE. Revisiting one-stage urethroplasties for distal urethral strictures. J Clin Med. 2021;10(24):5905. doi:10.3390/jcm10245905.

14. EAU Guidelines on Urethral Strictures, 2026: perioperative care. https://uroweb.org/guidelines/urethral-strictures/chapter/perioperative-care-of-urethral-surgery. Accessed September 12, 2026.

15. EAU Guidelines on Urethral Strictures, 2026: follow-up. https://uroweb.org/guidelines/urethral-strictures/chapter/followup. Accessed September 12, 2026.